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Volume 332:538-539 February 23, 1995 Number 8
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Clinical Problem-Solving: The Appropriate Degree of Diagnostic Certainty?

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 by Thibault, G. E.
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To the Editor: The case presented by Thibault (Nov. 3 issue)1 illustrates a very common problem in clinical cardiopulmonary medicine. A simple objective test is widely available that would probably have averted the extensive and expensive workup.

The patient's peak flow should have been measured in the emergency room before and after treatment with the bronchodilator. I suspect the flow rate would have improved, as did his symptoms. Such evidence supports a diagnosis of reversible airway disease, or asthma. This patient could then have been instructed to measure and record his peak flow daily or when he had any episodes . . . [Full Text of this Article]

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